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Hello- my first question here. I will be caring in my home for my 90 year old MIL who has dementia. She's in reasonably good shape physically for her age- she does walk with a walker though because of balance issues. She's in memory care right now, but has to leave because they feel they can't help her any further there. It's the nursing home or my home, so I want to try and see if I can care for her here. She's not a difficult person but has trouble following directions, and I know she's going to need assistance with cleaning herself. Am I correct in thinking that a walk-in tub would be easier for both of us rather than a walk-in shower? In a shower situation- (of course she would have a shower chair) it seems I would have to actually get in there to assist her, which seems messy and uncomfortable. Any insights are welcome. I'll be having a new bathroom put in just for her, so of course I'd like to get it all right. Cost is not really an object. TIA :)

If the people at MC feel that she is too much for them, why do you feel you can take this on? She must be ready for the next level of care or believe me they would keep her. It is not easy to care for someone with a Dementia, the reason she cannot follow directions. There is no rhyme or reason to the desease. And very unpredictable. Before I would remodel my house, I would make sure that you are able to do the job. You are a Senior too.

Putting in a walk in tub is very expensive. We had a walk in shower. Mom used a shower bench. I installed a handheld shower head. I kept the room warm with small heater. I would wet her down and turn off the shower. Then soap her down and rinse. Have a towel nearby and dress her as much as I could. Bathroom was small. I eventually placed Mom in an AL and eventually LTC. At 68 I could not do the showering and the toileting. And the accidents. One being a "blow out" that took 3 hrs of cleaning up. The bathroom first because she needed a shower. I had a small table outside her bathroom door. I caught her using it as the toilet.

I hope your husband is going to be helping in her care. You will have sleepless nights because she is roaming or trying to get out of the house. Just as you sit down, she will want something. Its like having a toddler again.

I do suggest that you try a commode over the toilet. There are splash guards that take the place of the bucket. This will give MIL the arms and legs for stability.

Good Luck if you go ahead with this. If you find that her care is beyond you, please don't feel guilty. I personally could not do it because of the unpredictability. I like knowing what comes next. I like organization. Don't do well when a ball in thrown into the mix.
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HisBestFriend Jan 25, 2022
This is good advice and I thank you also, JoAnn29. I am becoming a fan of your helpful answers here.

I am reaching a point where we must start looking at some bigger stronger more competent help for me with my DH at home. I had wanted to keep him here for the duration. It is slowly, but surely, dawning on me that this is probably not a good idea.

In saying all that, Silvie, I did have the big whirlpool bath taken out and replaced with a ceramic shower with a bench. The shower itself is great, the shower-ee is the problem! As you said, if the MC can't do it, how can a person alone do it? Will your DH help in the bathroom with a naked mom?
Think this over, and I also think you are an extraordinary princess for even wanting to do this, your MIL is a very lucky woman, and you DH also. Best of luck and God Bless.
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I'll address in a general way some of the issues people brought up. Of course, I have thought long and hard about this. At the MC place where she is currently, they are legally not able to bathe her or help her eat, but really, she just needs a little assistance in those regards, and it seems a shame, to me, that she has to go to a nursing home for those reasons- so I offered to do this. She may well end up in the NH as time goes on, but for now I'm happy to try caring for her here. If it doesn't work for whatever reason- there is still the NH option. I have a spacious home that has 3 full bathrooms, one on each floor, and those will remain as they are. She will be in two nice rooms in the walk-out basement- which have been unused- and her bathroom will be a new build, just an extra bathroom. I am not concerned about resale value. With three others, I doubt it will matter. She will be monitored closely and when someone is not with her, she will be in a safe, secured area and not free to roam the entire house or go outside on her own. I will have help. She is not in the least a difficult person. Thank you all for your concerns. And, special thanks to those who helped me with the shower info. I have a much clearer picture of what I need to do in that regard.
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Chris52 Jan 25, 2022
Silvie, I am glad you are doing this. Why not try? All dementia is different, and you may never have the problems that some others assume. If you do have difficulty, you will make decisions as you need to.
I will forever regret not going to greater lengths to keep my parents in their home a little longer.
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I’ve been through a lot of stages of disability. In my opinion, a tub is limiting both for the person with needs and others. A roll-in shower allows many options long-term. The most important advantage of a shower is space. A person can wash or be washed in a shower. Don’t opt for a built in or fold down seat, the positioning of those is rarely an advantage; instead use whatever moveable shower chair works best for the present needs. Do include plenty of grab bars and a lower hand held spray nozzle. A ceiling light in the shower is helpful, and a ceiling heater in the bathroom affords much comfort. Hope whatever choices you make work well.
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My dad had friends who put in walk in tubs and all quickly grew to hate them. They had to sit and wait for the tub to fill, cold and unclothed. After the bath, the reverse was true, sitting there wet and cold waiting for the tub to drain. We put in a walk in shower for my dad, he had great success with it, there was a seat and no wait for warm water or for getting out
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Even if you don't have room for a fully ADA compliant accessible bathroom you can still do a lot to enhance accessibility. My remodel included widening the door and replacing the big vanity with a smaller profile pedestal sink (I think a wall hung sink would have been better but there were time and budgetary restraints). One of the key features in a wet room is the level floor, over time even the three inch step into our low profile shower became stumbling point for my mom, and once she could no longer stand and pivot from her wheelchair it may as well have been a wall.
Don't forget lots of properly anchored grab bars. And don't let anyone talk you into a shower unit with a built in bench, they are not adequate for accessibility.

Oh... for safety and accessibility plan for a curtain not an enclosure

As for the how to - try searching shower assistance for elderly on YouTube for videos
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I'd opt for the shower, and since cost is no barrier I'd make the whole bathroom into a completely accessible wet room

My reasoning:
there may come a point where she needs a wheelchair
she will likely need assistance doing the actual washing, and soaping up and rinsing off someone will be easier in a shower than reaching down into a tub, especially one of the high walled walk in tubs
once urinary and fecal incontinence become a problem it will be more hygienic to rinse off in a shower that to sit in a bath

Since you are renovating I'd also plan for a bidet sprayer or bidet toilet seat as well to help with toileting
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silvie Jan 23, 2022
Thanks, I understand your reasoning. Space is a bit of a problem; not sure I can do an area large enough to be considered a completely accessible wet room. It's a single room that will serve as both bedroom and bathroom. It does sound, however like maybe a walk-in shower or shower area might be better- I guess in that case, the caregiver understands she may get a little wet herself, yes? I am trying to picture the mechanics of the whole thing... also, if anyone has specific recommendations for a particular shower model, that would be great.
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Geaton's comment about shivering reminded me of something else - a heater! Even a warm bathroom will feel cold to someone who is wet when the curtain is left open because someone is assisting them.
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Geaton777 Jan 23, 2022
cwillie, yes! My mom has a space heater in her tiny bathroom.
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Get the shower.

Imagine the walk-in bathtub filled with water and the patient poops in it. Not firm poop that stays together due to roughage and fiber in the diet. No, runny poop like a baby. The bathtub water turns yellow and the dissolved poop is all over her body. YUCK!

In the shower the poop goes to the floor and the patient remains clean.

My dad would poop in the shower all the time (he was incontinent). A bathtub would have been disgusting.
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AliBoBali Jan 25, 2022
I didn't even think about that. Incontinence would be a big factor in tub vs shower. Also, since *everyone* has an urge to urinate in warm water, seems like that would only be more common in the elderly. :-)
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My solution for bathing a 97 yr old mobile impaired who with effort can transfer herself from bed to wheelchair was to finally keep our bathtub as is.

I purchased a Carousel Sliding Transfer Bench with Swivel Seat by Platinum Health, plus with a 32-inch Horizontal Extended Rails.  Also, have safety rails on all three sides of the bathtub.

Turn on the bathroom ceiling heater. If you don’t have a ceiling heater use a plug in heater in a safe location.

Wheelchair her into the bathroom. She transfer to the sliding seat on the outside of the tub.  Once in the seat, I slide her into the center of the tub.

Control the hand-held shower water stream to low and soft to avoid frightening her. Also, with the control hand-held shower I control the direction the water flows. Use the shower curtains for front and for back to avoid getting drenched.  

She uses the safety rails to raise herself so the most odor parts get washed. The ceiling heat keeps the room warm, no problem.

With the ceiling heat on, I sweat, but that’s okay, the job gets done.
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Maureenbh Jan 27, 2022
Wonderful answer and problemsolving
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It isn't messy and uncomfortable to help a person have a shower, not at all - just make sure you have a shower commode - i.e. a waterproof one so that you can literally wheel her into position - and a shower with a head that you can take off the wall and use to rinse her thoroughly. If you go for the bath you'll have much bigger problems with moving and handling as her mobility declines.

As you're having a whole new bathroom put in I can give you my personal wish list!

GOOD HEATING. A decent sized towel rail that also gets the room properly warm. Put it on the wall away from the shower so it doesn't get wet, but within reach so you don't need three hands or extendable arms to grab a towel when she gets shampoo in her eyes.
Non-slip flooring which must be easy to clean and dry and pleasant under foot - there are plenty on the market, but consider how you're going to maintain it and also how it will feel on her toes when they're bare and wet.
Looking at the shower wall - somewhere to put soap, shampoo, brushes and sponge when in use, such as a built in ledge. No grouting or tiling, avoid anything that can gather sludge, hair or mould.
Other walls - shelf storage and a bin. Otherwise the basin and shower will soon be cluttered with denture pots, toiletries, creams, boxes and goodness knows what, and plastic bottles are much more breakable when they drop on the floor than you'd think.
Good lighting. You need to be able to check skin integrity without having to bend down and peer at bits of her.
Good ventilation. Especially if either of you wears glasses.
Give serious thought to a bidet function on the toilet. Worth every penny both in terms of labour-saving and quality of outcome - they wash and dry a person's undercarriage really well without her getting upset or anyone else having to lift a finger (except to press Start).
No sharp corners. On *anything.*
No designer gadgets. A mixer tap (faucet, I mean, do I?) on the handbasin is a good idea but avoid space-age aesthetics or hidden controls. Hot should say Hot, Cold should say Cold, you shouldn't need a master's degree to let the water out.
Please make sure the handbasin is tall and deep enough to get a bedpan and/or the bucket from a commode under the tap (unless you have a separate sluice somewhere, not many family houses have) - not for emptying, obviously, but for 3 x filling to rinse, disinfecting, 1 x filling to remove disinfectant. The contents go down the lavatory pan, of course, but if you can't get the pan or bucket under the tap to fill it it's extremely irritating. I get very sick of dainty little dolly's handbasins that some numpty designer thinks anyone can actually wash anything at.

As MIL is currently able to stand and walk with support, it would be good to encourage that by having grab rails so that she can engage fully in showering herself and stand safely - but you are now in the realms of OT assessment and recommendations. Which it would be sensible to get anyway.
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